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RC Review > ID > Flashcards

ID Flashcards

1
Q

Manifestations of Malaria

A
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2
Q

Approach to Cervical Lymphadenitis

A
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3
Q

Congenital CMV

A
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4
Q

Risk factors for severe COVID-19

A
  • obesity
  • asthma
  • CLD
  • CHD
  • NDD
  • mental health
  • T1DM
  • multiple co-morbidities
  • feeding tube dependence
  • T21
  • immunocompromised
  • crowded living
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5
Q

COVID-19 risk factors for age < 2

A
  • CLD
  • neurologic conditions
  • CV disease
  • prem
  • airway abnormalities
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6
Q

High risk for influenza complications/hospitalization

A
  • children aged 6-60 months
  • cardiac or pulmonary disorders
  • diabetes or metabolic disorders
  • immunocompromised
  • renal disease
  • anemia or hemoglobinopathy
  • NDD or neurologic condition
  • morbid obesity BMI > 40
  • prolonged ASA treatment (reye syndrome)
  • indigenous people
  • chronic care facilities
  • pregnant
  • age > 65
  • household contacts of above conditions
  • household contacts of a newborn or young child
  • health care workers
  • working in confined settings
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7
Q

Contraindications to the Influenza vaccine

A
  • anaphylactic reaction to vaccine or component
    *NOT EGG
  • onset of GBS within 6 weeks of influenza vaccine and no other known cause
    *repeat dose if needing antivirals within 2 weeks, or stop for 48 hours prior to giving vaccine
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8
Q

Contraindications to Live Influenza vaccine

A
  • immunocompromised (except stable HIV)
  • pregnancy
  • chronic ASA therapy
  • not preferred in health care workers
  • severe asthma (currently wheezing, oral/high dose ICS, wheezing needing medical attention in last 7 days
  • defer if nasal congestion (delivery)
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9
Q

Risk factors for vertical transmission of HCV

A
  • high maternal titres
  • elevated ALT in year before pregnancy
  • maternal IVDU
  • fetal scalp moniitoring
  • pROM
  • infant female sex
  • second born twin
    genotype is NOT a risk factor
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10
Q

Higher risk of progressive cirrhosis in HCV

A
  • Genotype 1-alpha
  • co-infection with HIV or Hep B
  • steatosis on liver biopsy
  • HCC rare - highest risk with cirrhosis
  • extra-hepatic manifestations (membranoproliferative GN, hypothyroid/thyroiditis, elevated ANA)
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11
Q

Prevention of vertical transmission of HCV

A
  • treat prior to pregnancy
  • SVD vs. CS no difference
  • avoid mixing blood (episiotomy, scalp electrodes)
  • breastfeeding is safe (avoid if cracked nippled, damaged, bleeding, HIV)
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12
Q

Interpreting HCV Testing

A

< 2 months = cannot interpret
>/= 2 months +ve AB/+ve RNA = infected
2-17 months AB +ve, no RNA = repeat at 18 months
>/= 6 months -ve AB = negative
>/= 18 months +ve AB/-ve RNA = cleared

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13
Q

Risk factors for post-natal HCV

A
  • IVDU
  • women in correctional facilities
  • unregulated tattoos/piercings
  • medical blood products/equipment - remote
  • sexual/household contacts - minor role
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14
Q

Risk factors for maternal HIV

A
  • limited/no prenatal care
  • IVDU
  • recent illness suggestive of HIV
  • regular unprotected sex with high risk partner
  • Dx of STI during pregnancy
  • emigration from endemic area
  • recent jail
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15
Q

Differential Diagnosis of Erythema Nodosum

A

Erythema Nodosum:
-Occurs in all ethnicities, sexes, and at any age (but more commonly in young adult females)
-It is an inflammatory/hypersensitivity process, and can be idiopathic, or related to infections, inflammatory conditions, medications, and malignancy.

-Infection:
causes include viral and strep pharyngeal infections, HIV, HSV, TB, hepatitis, Yersinia, Campylobacter, Chlamydia, and fungal and parasitic infections.

-Medications:
Sulfonamide, amoxicillin, OCP, NSAIDs, salicylates, iodide, gold salt

-Inflammatory conditions:
IBD, Behcet’s, leukemia, lymphoma, sarcoidosis

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16
Q

HBV Prophylaxis after needle stick injury

A
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17
Q

Management of Needle Stick Injury

A
  • Hep C - no prophylaxic, AB testing in 3 and 6 mo
  • HIV - PEP if risk high (ideally within 1-4hr, no later than 72 hr)
  • clean with soap & water
  • tetanus status
  • HBV prophylaxis based on immune status

Follow-up
- 4-6 weeks - HIV Ab
- 3 months - HIV, HCV Ab
- 6 months - HIV, HCV and HBV Ab
- HBV vaccines at 1 and 6 months (2/3 doses)

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18
Q

Differential Diagnosis of Acute Limb Pain

A
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19
Q

Most common pathogens in SA or AO

A

S. Aureus, K. Kingae (decreasing colonization rates with age), S. pneumoniae, S. pyogenes.

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20
Q

When can you transition to oral antibiotics for SA/OA?

A
  • Afebrile
  • Ability to weight bear/mild pain with routine use
  • Decreased CRP (either < 50% over 4 day period, or CRO 20-30)
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21
Q

How long should you treat an acute osteoarticular infection for?

A
  • Total duration of treatment for AO is 3-4 weeks
  • Recommended during for SA if 3-4 weeks, or 4-6 weeks if the hip is involved
  • Discontinuation should be based on resolution of symptoms and normalization of CRP
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22
Q

HPV Vaccine

A
  • HPV-9 covers 6, 11, 16, 18, 31, 33, 45, 52, 58
  • 90% of genital warts and 85-90% of anogenital cancers
  • all children aged 9-14: two doses 6 months apart
  • age 15-26: give 3 doses
  • Immunocompromised & HIV: 3 doses
  • once eligible, always eligible!
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23
Q

Risk Factors for HPV

A
  • Higher lifetime number of sexual partners
  • previous STIs
  • History of sexual abuse
  • Early age of first sexual intercourse
  • Partner’s number of lifetime partners
  • Tobacco or marijuana use
  • Immune suppression
  • HIV
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24
Q

Meningococcal Vaccines

A

Men-C-C
- routine at 12months

Men-C-ACYW
- adolescent booster (or Men-C-C)
- Two or three doses recommended starting at 2 months of age for children at high risk of IMD due to underlying medical conditions, with a booster dose at 12–23 months, every 3–5 years until 7 years of age, and every 5 years thereafter
- post-exposure prophylaxis

4CMenB
- Two or three doses recommended starting at 2 months of age for children at high risk of IMD, due to underlying medical conditions, with a booster dose at 12–23 months, every 3–5 years until 7 years of age, and every 5 years thereafter
- Higher risk for exposure or post-exposure prophylaxis

MenB-fHBP
- Three doses (0, 1-2 and 6 months of age) in individuals 10 years of age and older at high risk of IMD due to underlying medical conditions
- two doses over 10 years of age to higher risk of exposure or post-exposure prophylaxis

Risk increased because of underlying medical conditions
- Asplenia or functional asplenia, including those with sickle cell anemia
- Properdin, factor D or complement deficiency (including those with acquired complement deficiency from eculizumab (Soliris); primary antibody deficiency
- HIV

Risk increased because of the potential for exposure
- Laboratory workers who work with meningococcus
- Military personnel living in close quarters
- Travellers to endemic areas (currently, travellers to sub-Saharan Africa andHajjpilgrims)
- Close contacts of a case of IMD

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25
Q

When do you give the rotavirus vaccine?

A
  • First dose at 6-8 weeks (before 15 weeks)
  • minimum 4 week interval
  • last dose before 8 months
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26
Q

Contraindications to rotavirus vaccine

A
  • hypersensitivity to ingredients
  • history of intussusceptioin/increased risk (meckel’s)
  • know or suspected SCID/immunocompromised condition
  • maternal tx with infliximab
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27
Q

Risk and Benefit of Circumcision

A

BENEFIT
- phimosis treatment
- decreased UTI by 90%
- STI rates decreased in HIV endemic countries
- penile cancer? (associated with HPV, phimosis biggest risk factor)

RISK
- pain
- bleeding
- local infection
- meatal stenosis
- fibrous adhesions

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28
Q

Ophthalmia Neonatorum

A

Untreated maternal gonorrhea - swab + CTX x 1 dose (if on IV calcium, give Cefotx)

Untreated maternal chlamydia - no swabs, Abx, just monitor (Sx = 2 weeks of erythromycin PO + 2 weeks topical)

Symptomatic infant = FSWU and Tx

If mom treated, repeat tests and only treat if positive (unless worried about FU)

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29
Q

Encapsulated Organisms

A

Some Nasty Killers Have Some Capsule Protection
- strep pneumo
- neisseria meningitisi
- klebseislla
- H. flu
- Salmonella
- E. coli
- Pseudomonas

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30
Q

Antibiotic prophylaxis in Asplenia

A

0-3 months = Amox-clav
3 mo - 5 years = Pen VK or Amox
> 5 years = Pen V

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31
Q

Asplenia Immunization Schedule

A
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32
Q

Management of 1st episode HSV

A
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33
Q

Management of Recurrent HSV

A
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34
Q

Treatment of Neonatal HSV

A

Acyclovir 60mg/kg/day div q8hr
- duration 14 days for SEM, 21 days for CNS/Dis

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35
Q

Management of bacterial meningitis

A

CTX + Vanco (+/- Amp if worried about Listeria)

Steroids for HIB, 2 days duration, given before to within 30 minutes of ABX (0.6mg/kg/day div 6hr)

Duration:
- S. pneumo: 10-14 days
- Hib: 7-10
- N meningitidis 5-7
- GBS: 14-21 days, longer if cerebritis or ventriculitis is present

*formal audiology assessment should be performed ASAP after diagnosis of meningitis and always before discharge from the hospital to optimize management in the event of hearing loss

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36
Q

Contraindications to LP

A
  • coagulopathy
  • cutaneous lesions at the puncture site
  • signs of herniation
  • unstable clinical status
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37
Q

Indications for CT in suspected meningitis

A
  • new onset seizures
  • focal neuro deficits
  • decreased LOC
  • coma
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38
Q

Indicators of poor prognosis in meningitis

A
  • delay in antimicrobials
  • severity of clinical state at presentation
  • isolation of non-penicillin-susceptible S pneumo
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39
Q

Indications for post-exposure prophylaxis in meningitis

A
  • meningococcal disease
  • Hib should be given to all occupants of contact households with infants <12 months old (who have not completed the primary Hib immunization series), children <4 who are incompletely vaccinated or immunocompromised kids of any age
  • any index case of Hib aged <2 years and not treat with cefotaxime or CTX should also receive chemoproph at the end of therapy
  • talk to public health about what to do with possible contacts at child care and school
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40
Q

Risk Factors for C. diff

A
  • duration of hospital stay, older age, exposure to multiple antibiotic classes, antineoplastic agents/chemotherapy, IBD/immunosuppressed states (including HIV/hypogammaglobulinemia)
  • GI surgery and manipulation of the GI tract (including tube feeding).
  • PPIs
  • **risk factors for severe disease: neutropenia with hematological malignancies or those with HSCT, infants with Hischsprung’s disease, patients with IBD
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41
Q

Treatment of C. diff

A
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42
Q

Complications of GAS Pharyngitis

A

Suppurative complications:
- peritonsillar abscess
- retropharyngeal abscess
- sepsis

Nonsuppurative complications:
- post-strep GN (not prevented by antibiotic treatment)
- Acute rheumatic fever

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43
Q

CENTOR score for GAS Pharyngitis

A

CENTOR Clinical decision rule
(only for children aged 3 to 14 years)
One point for each characteristic:
* Exudate or swollen tonsils
* Tender or swollen anterior cervical lymph nodes
* Fever
* No cough
If the total score is ≥3, do a throat swab. There is a 32% to 56% probability of GAS infection in such cases.

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44
Q

Treatment of GAS Pharyngitis

A
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45
Q

High risk for acute rheumatic fever

A
  • indigenous children
  • Canadian north children
  • overcrowded housing conditions
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46
Q

Treatment of GAS Carriage

A

Only recommended in high risk situations
- amox-clav x 10 days
- clindamycin x 10 days
- penicillin/amoxicillin x 10 days + rifampin for last 4 days

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47
Q

Clinical Features of Congenital CMV

A
48
Q

Investigations for congenital CMV

A
49
Q

Management Scheme of Congenital CMV

A
50
Q

Management of congenital CMV

A
51
Q

Laboratory Markers suggestive of MIS-C

A

CRP ≥50mg/Landat least one of the following:
- ferritin >500 mcg/L
- platelets <150 x109/L
- lymphopenia <1.0 x 109/L
- hypoalbuminemia
- neutrophilia

52
Q

Tx for mucocutaneous candidiasis

A
  • oral nystatin
  • PO fluconazole/itracondazole if failure
  • topical antifungal if diaper
53
Q

Tx for pityriasis versicolour

A
  • topical ketoconxaole, selenium sulphide & clotrimazole
54
Q

Treatment of ringworm

A
  • topical clotrimazole, ketocnozaolr, miconazole or terbinafine
    avoid steroids
55
Q

Tx of tinea pedis

A
  • topical antifungals x 4 weeks
56
Q

Tx of tinea capitis

A

oral terbinafine x 4-6 weeks
send scalp scrapings

57
Q

Tx of pityriasis capitis

A

mild soap/shampoo

58
Q

Invasive GAS Definition

A

Severe IGAS: with laboratory confirmation, clinical evidence of severe invasive GAS disease includes the following:
a. Streptococcal Toxic Shock Syndrome (TSS): hypotension (sBP < 5th percentile for age) AND at least 2 of:
i. Renal impairment (creatinine 2X ULN or 2X baseline)
ii. Coagulopathy (plt < 100 or DIC)
iii. Liver enzyme abnormality (AST, ALT, or bilirubin > 2X normal for age)
iv. Acute respiratory distress syndrome
v. Generalized erythematous macular rash that may desquamate
b. Soft tissue necrosis (NF, myositis, gangrene)
c. Meningitis
d. Pneumonia (with isolation of GAS from sterile site, such as pleural fluid - not BAL)
e. A combination of the above
f. Any other life-threatening condition or infection resulting in death

59
Q

Management of Invasive GAS

A

Empiric antibiotics:
* TSS: Beta-lactamase stable beta-lactam (ex. cloxacillin) + Clindamycin + Vancomycin (due to association with MRSA).
* NF: Pip-Tazo/Carbapenem + Clindamycin (toxin neutralization) + Vancomycin
○ Definitive diagnosis and management of NF includes emergent surgical exploration.
* Confirmed GAS: Penicillin + Clindamycin (stop after 48-72 hours if hemodynamically stable, sterile blood and no further progression of necrosis)
○ There is 10-15% rates of resistance to clindamycin, compared to 0% resistance in GAS to penicillin, so should NOT be monotherapy.

Intravenous Immunoglobulin (IVIG): should be considered with streptococcal TSS or severe invasive disease (toxin-mediated) especially if severely ill or refractory to aggressive fluid therapy.
Dose: 150-500mg/kg/day for 5-6 days OR 1-2g/kg x 1 dose.

60
Q

Close contacts of Invasive GAS

A

Definition Close Contacts:
* Household contacts with > 4 hrs/day or a total of 20 hrs within the last 7 days
* Non-household contacts with bed-sharing or sexual relations
* Direct contacts with mucous membranes or unprotected direct contact with an open skin lesion
* IVDU with shared needle
* Contacts in childcare setting

Chemoprophylaxis: offered to close contacts of severe cases exposed within 7 days prior to symptom onset to 24h after antibiotics were initiated. Started as soon as possible (ideally within 24 hours of identifying a case, but done up to 7 days).

61
Q

Vaccine Preventable Diseases

A
  • Polio - asymptomatic or acute paralysis (asymmetric)
  • Measles - cough, coryza, conjunctivitis and Koplick spots (blue-white) and descending rash
  • Diptheria - rapidly progressive neck swelling + resp compromise from pseudomembrane (grey) on throat
  • tetanus - muscle rigidity and spasms
  • Mumps - parotitis, orchiditis, mastitis, oopheritis, pancreatitis, meningitis
62
Q

Close Contacts of TB

A
  • When a child/youth is identified as a contact of an index case: Hx, PE, CXR, initial TST are essential
  • Case drug sensitivities are required
  • Children < 5 with an negative TST should receive preventative prophylaxis (one TB drug) using an drug that the case is sensitive to
  • repeat TST at 8-10 weeks after last contact
  • If negative at 8-10 weeks, can stop medication
  • Children > 5 with negative TST needs a repeat 8-10 weeks later - prophylaxis not recommended
  • if asymptomatic with normal CXR but positive TST = treat for latent infection
63
Q

Laboratory testing for TB

A

Specimens for microbiology:
- Sputum production - induced by hypertonic saline
- Fasting gastric aspirates (cannot expectorate sputum) on 3 consecutive mornings
- Bronchoscopy
- Send in sterile contains without formalin for acid-fast bacilli stains and culture (AFB) with possible nucleic acid amplification testing (NAAT)

ALL patients with TB disease require serology for HIV

TST and IGRA
- tuberculin injected intradermally in a TSTS causes a type IV hypersensitivity reaction if person is infection with MtB, have cross reactive antigens from non-tuberculous mycobacteria or from the BCG vaccine
- > 5mm induration if immunocompromised or > 10mm = positive
- IGRA: blood test to evaluate for TB - no cross-reactivity
- Both false negative with immunosuppression and neither determines latent vs. active

Children < 2 - TST is more sensitive

64
Q

High risk groups for severe influenza

A
65
Q

Anti-viral treatment for influenza

A
66
Q

Risk factors for STIs

A
67
Q

When should you do a test of cure in STIs?

A

Test Of Cure is Recommended when:
- Second-line or alternative treatment is used
- Antimicrobial resistance is suspected
- High re-exposure risk exists
- An adolescent is pregnant
- Previous treatment failed
- In cases of pharyngeal or disseminated infection
- Signs/symptoms persist following treatment.
***Repeat screen using NAAT six months after completing therapy is recommended for all individuals at risk for reinfection.

68
Q

Treatment of STIs

A
69
Q

Tests for STIs

A

Chlamydia - NAAT (most sens/spec), culture for medical-legal purposes

Gonorrhea - NAAT, cultures for medical-legal or concern for resistance

Syphilis - Serology (treponemal test with confirmatory test)

HIV - serology (screening assay confirmed with western blot)

70
Q

Treatment of Lyme Disease

A
71
Q

Clinical Manifestations of Lyme Disease

A

Early Cutaneous
- erythema migrans rash (7-14d at bite site)
- > 5cm, oval, flat/slightly raised
- arthralgia
- HA
- fever
- malaise
- mild neck stiffness
- myalgia
*self resolves in 4 weeks

Late Extracutaneous
- facial nerve palsy (10%)
- arthritis ( 30%)
- heart block/carditis (1%)
- meningitis (lymphocytic predominant) (1%)

72
Q

Diagnosis of Lyme Disease

A

Early - clinical (usually antibodies not detectable in 1st 4 weeks)

Late - ELISA screening and confirmation with Western Blot

73
Q

Prevention of Lyme Disease

A
  • shower within 2hours
  • check body fully
  • DEET or icardin repellents
  • chemoprophylaxis selectively (doxy, known endemic regions, 1 dose)
74
Q

Jarish-Herxheimer Reaction

A

Clinically worsening for <24 hours after initiating treatment for Lyme disease - start NSAIDs and continue treatment

75
Q

Management of MRSA skin abscesses

A
76
Q

Features of Congenital Zika

A
77
Q
A

Congenital Syphilis

78
Q

Late onset manifestations of Syphilis

A
79
Q

Treatment of Congenital Syphilis

A

Pen G x 10 days

80
Q

Evaluation for Congenital Syphilis

A

CBC, Liver enzymes, syphilis serology
CSF for RPR
Long bone X-rays
Hearing/vision testing

81
Q

Clinical Manifestations of Congenital Toxo

A

Triad: hydrocephalus, parenchymal calcifications, chorioretinitis

+ HSM
thrombocytopenia
hepatitis
macrocephaly

82
Q

Treatment of congenital toxo

A
  • pyrimethamine, sulfadiazine + leucovorin x 12 months
  • steroids for eye disease
  • VP shunt for hydrocephalus
83
Q
A

Congenital Varicella

84
Q

Timing of Varicella Exposure

A

1st/2nd trimester = Congenital VZV
3rd trimester = neonatal/childhood shingles
Perinatal (5 & 2) = disseminated VZV

85
Q

Management of chickenpox exposure in pregnancy

A
86
Q

PDA, Cataracts, SNHL

A

Congenital Rubella

87
Q

Classic Findings of Congenital Infections

A
88
Q

Common brain imaging findings in congenital infections

A
89
Q

Management of pregnancy exposure to Parvovirus

A
90
Q

Congenital Infections by Presenting Symptom

A
91
Q

Approach to well term infants at risk for early onset sepsis

A
92
Q

Low risk criteria for febrile, well-appearing infants 29-90 days

A
93
Q

Approach to well appearing febrile infant 7-60 days

A

< 21 days = FSWU + Abx
21-28 days = U/BCx + IM, LP and Abx if abnormal
> 28 days = U/BCx + IM, LP if abN, Abx if LP abnormal, consider if IM abnormal

94
Q

Manifestations of Neonatal HSV

A
95
Q

Management of Acute Otitis Media

A
96
Q

Diagnosis of AOM

A
  • Acute onset of symptoms
  • Middle ear effusion (MEE)
  • Significant inflammation of the middle ear (differentiates otitis media with effusion, OME, from AOM)
  • Acute perforation with purulent discharge (otorrhea) - high rates of GAS
    (Differentiate from otitis externa for chronic drainage)
97
Q

Complications of AOM

A
  • Most common complication: acute mastoiditis (Pain or swelling over mastoid bone suggests this)

Other complications:
- Acute facial nerve palsy (temporal bone inflammation)
- Sixth cranial nerve palsy (petrous bone inflammation or infection - Gradenigo’s syndrome)
- Labyrinthitis (infection in cochlear space)
- Venous sinus thrombosis of transverse, lateral or sigmoid venous sinuses
- Meningitis

98
Q

Antibiotics for AOM

A
99
Q

Definition of TSS

A

Hypotension/Shock + 2 of:
- renal impairment
- coagulopathy/DIC
- hepatic abnormalities
- scarlet fever rash
- ARDS
- soft tissue necrosis

Need isolation of strep from sterile site!
*No isolation of staph needed, but need 3 systems involved

100
Q

False negative TST

A
  • active TB disease
  • immunodeficiency
  • corticosteroids
  • young age < 2
  • malnutrition
  • viral infections
  • live vaccines
101
Q

Side Effects of TB medications

A
  • INH = hepatotoxicity, peripheral neuropathy, B6 deficiency = seizures (pyridoxime metabolism)
  • Rifampin = hepatotoxicity, hypersensitivity rxn, memory impairment, fluid turns orange
  • Pyrazinamide = hepatotoxicity, increased uric acid
  • ethambutol = optic neuropathy
102
Q

Definition of a positive TST

A
103
Q

Treatment of TB

A
104
Q

Clinical Features of Childhood HIV

A
105
Q

AIDS Defining Conditions

A
106
Q

Side effects of zidovudine given for HIV prophylaxis

A

Anemia + Neutropenia

107
Q

HIV status definition in newborn exposed infants

A

Positive
- PCR positive x2 before 18 months
- reactive serology 18-24 months

Negative
- PCR negative x2 at > 1 month and > 2 months

108
Q

Live vaccines in immunosuppression

A

+ 1 month after high-dose steroids (>/= 2mg/kg/day pred)

109
Q

General Vaccine Schedule

A
  • DPTaP-Hib & PCV13 need multiple doses < 12 months
  • no MMR < 12 months
  • first influenza is 2 doses separated by 1 months
  • PCV & Hib most important for pre-school
  • Everyone needs: 3x DDtap-IPV-PCV, 2x MRR, 2x V, 1x MenC-
  • another MenC (conj) in adolescence
110
Q

Indications for VZIG

A
111
Q

Tetanus Exposure Prophylaxis

A
112
Q

Rabies Exposure Prophylaxis

A
  • domestic = observe for signs of rabies
  • wild = euthanize and test
  • rabies IG given into would + IM
  • rabies vaccine given on day 1, 3, 7, 14 +/- 28
113
Q

School Exclusion Policy

A
114
Q

Management of MIS-C

A
115
Q

High Risk for Invasive Meningococcal Disease

A
116
Q

Prophylaxis for Pertussis

A

RC Review (26 decks)

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